Becoming dysfunctional
Based as a medical anthropologist on clinical rounds in hospitals and clinics in the Limpopo and Cape Provinces, I met Shangaan and isiXhosa-speaking men who, because of ‘botched circumcisions’ had penile dysfunction. Patient confidentiality protects their stories but one, whom 1 refer to as Mthunzi, has salience. Admitted to a general medical ward with renal failure, his circumcision had taken place five years previously. Despite his Xhosa mother pleading with him not to go, and with his father absent, he ran away to the circumcision school. Mthunzi was 16 years old. He did not sign consent forms, but officials in corrupt practices broke the rule that a father must take his son and circumcised him.
On the ward, Mthunzi explained that, after his circumcision, the wound did not heal, he was unable to urinate, and was in acute pain. He said that, “without a father to watch over him, he did nothing about it”. Eventually the wound closed over but, by the time of his coming out, he was desperate. Stating that he still suffered pain while urinating, Mthunzi confessed to terrible pain when having sex and that he felt depressed most of the time. Although he had a girlfriend, taboos silencing pain meant “this had remained a secret” as was the fact that he could no longer function “sexually or otherwise as a man”. This, he described, “was a big burden for him on his heart”. Crowley and Kesner (1990) describe a link between circumcision, renal failure, and mental illness and this corresponds with his presentation. Doctors in the hospital diagnosed him as being unable to urinate due to fibrosis from the scarring and therefore, he was suffering from severe renal failure. An added trauma was the death of his friend in the circumcision ground.
Mthunzi’s death, which was imminent, should have been recorded in the government’s twice-yearly morbidity and mortality statistics for circumcision practices. Instead, it sits alongside my remarkably few accounts of traumatic injury. Kepe (2010) describes the Xhosa men who come from botched circumcisions as dysfunctional and burdened with untreated physical or psychological injuries. Yet, if the statistics for these injuries are correct, many Xhosa men must embody severe dysfunction. In addition, their suppression and silencing of pain and harm must weigh heavily on them. This, in turn, insidiously contributes to the burden of untreated physical and mental illness in these communities. In contrast to an instantiation of resilience, embedding injury in uncomplaining Xhosa men depressingly alters the mental health of their partners, family, and friends (Duncan, Swartz, & Kathard, 2011).
Mr Gebe’s explanation for mental illness in circumcision
Of initiates return to ‘the bush’ after hospital, Mr Gebe gave this explanation about how officials re-assimilate him:
“ When a youth such as this is hospitalized then the initiates who have remained in the bush do not know that he was in hospital but think he was visiting another initiate. This was to maintain their status (as an initiate ) and disguise the truth in order to complete the tradition. ” Voicing an African belief about compassionate behaviour towards others, he added, “It was possible to educate initiates in the bush and ask them to accept a youth with sepsis. He was a human being like them”. He cautioned, “If the youth dies, then his clothes and blanket are brought in to show he was ‘late’. ”
Another complex issue for circumcision officials was youth, like Mthunzi, who, too young and over-eager to go, faced dire consequences. " When youths want to go and are too young, they can commit suicide”, Mr Gebe confided. He knew of cases like this, describing errant youth as “foolhardy“ and taking too many risks. Psychological immaturity underlay their behaviour, as did broader issues relating to social harm in absent fathers, and poor “early decision-making processes” in the family. Resilience, he argued, came from careful, mature, deliberate thinking and familial negotiation and the reverse was true for harm. My anecdotal evidence on suicides in young Xhosa men post their circumcisions suggested that while their maturity, and family conflict was a problem, what most affected them was sexual preference. These new men appeared unable to reconcile their preferred gender as homosexual men with the values propounded for heterosexual males in circumcision. They felt homosexuality was explicitly, negatively framed. Their suicides reflected feelings of untold shame and fear of rejection, bringing distress to their families. Two stories were of adolescent Xhosa men who having grown up in privileged suburbs in Cape Town and attending the best schools had asked to go for circumcision. Whilst cultural dissonance was a potential stressor, disclosing their sexual preference was far worse. Of note in this respect is that, in everyday life, flaunting one’s sexuality belongs within a Western European modernity.
Mr Gebe described a propensity within this engendering that instigates mental disorder when morality is delinked from custom and injunctions disobeyed. He said:
If you were mentally disturbed, you could still go to the bush. People get beaten if they cannot go to the bush. Nevertheless, in the bush those who are mentally Hl can disrupt the (their) wound healing process and then the penis needs to be amputated. Then they are mentally confused. Everyone must be circumcised because there are no homosexuals or gays in Xhosa society in their territory.
His is a complex cultural argument, which portrays the attainment of manhood as brutal in its application of injunctions for youth who are remiss. He suggested that there is little compassion or, indeed, accommodation for those who, prior to going or in seclusion, are mentally disturbed and this includes doubtful, vulnerable, gentle in nature (Vincent, 2008a, 2008b; Wood
& Jewkes, 2001). Injunctions moreover are definitive; all youth should go and there is retribution for those who do not. Of significance is the requirement that initiates reject any peer who leaves initiation; a peer who dies and whose clothes are brought out is then wiped from memory. No initiate can mourn his peer’s death and no parent a son’s.
Paradoxically, in facing these definitive, brutal injunctions within a culturally bounded rite of passage which confines space and time, resilience becomes engendered (Ntombana, 2011). Injunctions therefore speak to the embedded nature of preconditions which once hedged the attainment of manhood. Mr Gebe used a tautological argument to rationalise their cultural and engendering purpose. Injuries, for instance, he ascribed to initiates who were disturbed because, in being mentally ill, they self-inflicted injury. Injury denoted bewitchment or mental disturbance, therefore the practice could not be blamed (Cheetham & Cheetham, 1976). In continuing he proffered a cultural injunction against homosexuality and appeared to link this with mental disturbance, suggesting that this prevents men from fulfilling their obligation to transact gender-described sexual and social relatedness. Pragmatically, he explicitly linked the attainment of manhood to a youth’s ability to endure pain, embody resilience, and conform to autochthonous notions of heterosexuality.
In linking circumcision to heterosexuality and resilience, Mr Gebe rejected notions of mental disturbance amongst the Xhosa, linking this to homosexuality which stood, in his explication, to contradict this embodiment of manhood. In his moral discourse, homosexuality and "gay” culture were explicit features of a European modernity that did not exist in this amaXhosa "territory". Yet, Xhosa people I spoke to about the link between circumcision, gender, and sexual preference gave varied reports; apparently (and this is arguable), in the past sexual preference was a question of personal choice; homosexuality was silenced in a public domain, for heterosexuality, as part of sexual reproduction, was explicitly celebrated in this reciprocated engendering ritual. Ntozini & Ngqangweni, interviewing nine gay men who went for circumcision concur, indeed their families hoped that initiation would convert them from homosexuality to heterosexuality, the culturally expected norm. They told of how circumcision meant they become equal to heterosexual men and show resilience. They, “resisted attempts by the ritual to change their sexual identities regardless of any feelings of marginalisation. For most gay initiates to be fully accepted, they either had to pretend or had to deny who they were by adopting roles such as being nice in order to fit in. While some simply withdrew from aspects of the ritual, others were more overtly resistant” (Ntozini & Ngqangweni, 2016, 1317). Interestingly some were cautious about how they expressed and engaged in loving relationships during seclusion. An emotive feeling, gay love featured in the movie “Inxeba: The Wound” which showed a complicated love triangle between an initiate and two mentors during seclusion. Traditional leaders wanted it to be banned because they felt it was culturally insensitive, but gender activists claimed this was homophobia, (BBC News Africa, 2018). However, the film instigated a vibrant
Negotiating harm 163 debate on gendered identity, sexuality, culture, and the imagined in ‘(black) masculinity’ (Siswana & Kiguwa, 2018).
